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Training hubs for healthy country communities

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BY AMA VICE PRESIDENT DR TONY BARTONE

Regional and rural communities face a range of disadvantages when compared to their city counterparts, not the least which is getting timely access to a doctor.

People living in these areas often have to travel significant distances for care, or endure a long wait to see a GP close to where they live. Getting to see other specialists can be even more difficult.

Inequalities such as these mean that they have lower life expectancy, worse outcomes on leading indicators of health, and poorer access to care compared to people in major cities. Death rates in regional, rural, and remote areas are higher than in major cities, and the rates increase in line with degrees of remoteness.

The overall distribution of doctors is skewed heavily towards the major cities, which means that regional and rural areas are affected by workforce shortages more acutely.

The problem is not a shortage of medical graduates. With medical school intakes now at record levels, we do not need more medical students or any new medical schools – something which the AMA and the Government can agree on.

What is needed are more and better opportunities for doctors, particularly those who come from the bush, to live and train in rural areas.

The evidence shows that they are the most likely to stay on and serve their rural community when they qualify.

Until now, the approach of Federal Governments of all political persuasions to getting younger doctors to the bush has been bonded workforce programs.

This has failed miserably because it did not address the underlying causes of medical workforce shortages, nor make the practice of medicine in areas of medical workforce shortage any more attractive.

I’ve met bonded graduates who decided to buy their way out of the deal.

Though many medical students have positive training experiences in rural areas, progression through prevocational and vocational training often requires a return to the cities.

At this point many trainees develop the personal and professional networks that are not easy to leave. Not surprisingly, many of these trainees are less able to return to practise in under-serviced areas.

Three years ago the AMA developed a significant proposal to address these problems – regional training networks. We see these as vertically integrated regional networks of health services and prevocational and specialist training hubs.

The networks would build on existing infrastructure and enable junior doctors to spend a significant amount of their training in rural and regional areas, only returning to the city to acquire specific skills.

We believe that regional training networks can improve the distribution of the medical workforce distribution by enhancing generalist and specialist training opportunities, and by supporting prevocational and vocational trainees to live and work in regional and rural areas. It is an idea whose time has come and supported by many players in the rural health space.

I was therefore very pleased when the Government announced last month that it will establish 26 regional training hubs across every state and in the Northern Territory, costing about $28.6 million.

According to the Government, the hubs will integrate health services, the medical colleges and other training organisations to increase postgraduate medical training opportunities.

It will be important that the Government works closely with the Colleges and other stakeholders to ensure the program helps to provide the regional vocational training places that are so badly needed.

There is a long way to go before the shortage of doctors in the bush is fixed, but nonetheless, this initiative is an important step in the right the direction. I believe it could make a real difference to access to medical care for regional and rural communities if implemented properly.

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